MEDICARE: ALIZZA LUCERO RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	002026338	CO

General Provider Information

NPI Number	:	1093540627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIZZA LUCERO RDH

Provider Business Mailing Address
First Line	:	8801 ABBEY RD
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-9778
Country	:	US
Telephone Number	:	720-474-9054
Fax Number	:

Provider Business Practice Location Address
First Line	:	6436 S US HIGHWAY 85-87 STE C
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1005
Country	:	US
Telephone Number	:	719-392-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/04/2024

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